Sinus Disease

[MEF]

I have had numerous infections since January 2004.  I have had Mono, Strep Throat and numerous sinus infections.  I have seen my family doctor and an Allergist.  The allergist did a scratch test and I had no reactions.  Finally, my family doctor had me get a CT Scan and I was diagnosed with Sinus Disease.  They put me on Cortisone and antibiotics and now I am on AllegraD.  Keep in mind that I have been given different typed of antibiotic for the past 6 months.  I have been ok for about a month and am getting another sore throat.  I am going to have sinus surgery, but before I do I wanted to see what others have to say about this.  Any information you can give me would be greatly appreciated.

[National Jewish]

Sinusitis is an inflammation of the mucous membranes that line the sinus cavities.  Inflammation of the sinuses could be due to an allergy, an infection, or ongoing exposure to an irritant, such as pollution or smoke.  The best way to identify a sinus infection is with a sinus CT scan, although sinus x-rays are a decent alternative.  A sinus CT scan will also identify if any of the openings that drain your sinuses are blocked.  If your sore throat is due to sinusitis, it will last as long as the inflammation continues.  Here are some ways to clear up the inflammation.  Please check with your doctor to see which of these would work best for you.  Usually sinus surgery is considered when these techniques have not been helpful.  Please read our Sinusitis MedFact at http://www.nationaljewish.org/medfacts/sin.html for more information.

The most common cause of sinusitis is an infection, especially when the mucus is green.  Sinus infections can be difficult to treat since they respond slowly.  When any of the openings that drain your sinuses are blocked it will take longer to clear a sinus infection.  If a viral infection is the cause it’s a matter of time until the sinusitis clears on its own.  When a bacterial infection is the cause you may need to take an antibiotic for at least 3 weeks.  Even after an antibiotic clears the infection, it is possible for the inflammation to linger.  However, inflammation of the sinuses could also be due to an allergy or ongoing exposure to an irritant, such as pollution or smoke.  Since you had no reactions to the scratch test done by the allergist, allergy is probably not the cause of your sinus disease.

This inflammation can block sinus drainage and cause increased mucus production.  As the sinus infection clears, this mucus drains from the nose and sinuses down the back of the throat causing a constant or intermittent postnasal drip and sore throat.  This mucus can also fester sinusitis.

The fat content in dairy products can thicken mucus.  Generally eating dairy products with less fat content is helpful.  Drinking plenty of water will help to thin the mucus so that it moves more easily.  As long as you are not on a fluid restriction you should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily.

An antihistamine can dry up the postnasal drip.  However, it may make the mucus thicker and more difficult to move.  A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and relieve your blocked sinuses by decreasing the swelling so they drain better.  A combination antihistamine-decongestant, like the Allegra-D® (fexofenadine/pseudoephedrine) that you are taking, will do both.  Often a prescription antihistamine and decongestant are taken only when the postnasal drip gets bad.  It may be more helpful to take the antihistamine and decongestant on a regular basis.

A nasal wash helps remove mucus and germs from the nose and sinuses.  This can temporarily decrease the postnasal drip and help your sinuses to drain better.  Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique.  Share this information with your doctor to see if you would benefit from this daily treatment.

If your symptoms continue, your doctor may recommend a prescription nasal steroid spray.  There is much less risk of side effects, so this is a good option instead of taking cortisone.  This can decrease mucus production and improve sinus drainage by decreasing the inflammation in the nose and openings that drain the sinuses.  This generally provides a more lasting decrease in sinus pressure and improves sinus drainage.  To get the most help from a nasal steroid spray use it after doing a nasal wash.  A nasal steroid spray does not provide immediate relief of symptoms.  It may take several weeks of routine use to become effective.  Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering you.

[Ellis7]

See:
http://www.entnet.org/healthinfo/sinus/sinus_surgery.cfm
Fact Sheet: Sinus Surgery
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http://www.aafp.org/afp/980901ap/slack.html
Functional Endoscopic Sinus Surgery
"Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure. Fiberoptic telescopes are used for diagnosis and during the procedure, and computed tomography is used to assess the anatomy and identify diseased areas. Functional endoscopic sinus surgery should be reserved for use in patients in whom medical treatment has failed. The procedure can be performed under general or local anesthesia on an outpatient basis, and patients usually experience minimal discomfort. The complication rate for this procedure is lower than that for conventional sinus surgery. "
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http://asthma.nationaljewish.org/about/relationships/sinusitis.php    Sinusitis
"For a small group of patients medications alone are not enough to completely clear sinus infection and inflammation. For those patients who fail to respond to medical treatment and have significant symptoms, surgery may provide a very important option in their care. However, surgery is not a cure for most forms of sinusitis and must be used in combination with appropriate medication. New technologies and advanced techniques in the field of endoscopic sinus surgery allow for improved patient outcome, fewer complications and more rapid recovery."

[Concerned lady]

You may also find some interesting information in a book called Sinus Survival, by Dr. Robert Ivker, D.O.